Botulinum toxin aftercare: the first 24 hours

The treatment ends when the clinical team cleans the area. What you do in the next few hours still counts.

The reason is simple. The toxin is placed in the right muscle and, in the first hours, it is binding to that muscle's nerve endings. Anything that raises blood flow, puts pressure on the area or raises your temperature can carry it where it should not go. That can mean an asymmetry, a lower brow or a short effect.

What not to do

Exercise in the first 24 hours. Heart rate up, temperature up, more blood through the treated area. Wait 24 hours. For high-intensity training, 48.

Lying down in the first 4 hours. Lying flat or bending your head well forward can move the toxin before it binds. Stay upright, sitting or standing, for 4 hours.

Touching, massaging or rubbing the area. Direct pressure shifts the product. In the first hours, no rubbing with a towel and no circular motions when washing.

Alcohol in the first 24 hours. Alcohol widens the vessels and adds bruising. The glass of wine waits until tomorrow.

Intense heat for 48 hours. Sauna, steam room, very hot baths, long sun. Heat reduces the product's stability and adds swelling.

Other facial treatments for 2 weeks. Facial massage, peels, laser, radiofrequency, anything with pressure, heat or abrasion on the area. If you have several treatments planned, the toxin goes last.

Makeup in the first 4 to 6 hours. After that, yes, with a light touch over the injection points.

Anti-inflammatories without a reason. Ibuprofen and aspirin add bruising. If you need a painkiller on the day, paracetamol. If you take omega-3, vitamin E or ginkgo, ideally stop 48 to 72 hours before the treatment.

Almost all of these apply to the first 4 to 24 hours. After that, your routine goes back to normal.

What to do

Drink water as usual. If there is swelling, a cool compress, never ice straight on the skin. SPF 30 or higher if you go out, especially in the first 48 hours. Your usual moisturiser and serum are fine, as long as you are not massaging the area.

Make your normal expressions. Smile, frown, talk. Despite what you may have heard, moving your face does not shift the toxin.

And come to the review at two weeks. That is where the real result is seen and a touch-up decided, if needed.

The first 7 days

First 4 hours. Upright. No touching. No heavy makeup. No alcohol. No heat. After 4 hours you can wash your face with lukewarm water.

Hours 4 to 24. Sleep however you like. You can wash your face and apply makeup gently. No exercise, no alcohol, no sauna, no long sun.

Days 2 to 4. You start to notice less movement in the treated areas. Not the final result yet. Moderate exercise is fine. No sauna, no peels.

Days 5 to 10. The effect settles. One side may look more relaxed than the other at this stage; symmetry is judged at two weeks. Exercise and skincare back to normal.

Day 14. Result established. Review: the effect is assessed, comparison photos taken, a touch-up done if needed.

When to contact the clinic

The great majority of treatments go without incident. Four signs deserve a message or a call:

• The upper eyelid has dropped. Rare. It happens if the toxin reaches the muscle that lifts the lid. It shows between day 2 and 5 and passes with time; there are drops that help meanwhile.
• Clear asymmetry after two weeks. Small differences in the first week are normal. A clear difference once the result has settled is corrected with a touch-up.
• Pain that does not ease, or swelling with heat and redness. Uncommon. A small bruise is normal and fades in days.
• A very weak effect after two weeks. In first treatments or with very strong muscles, the dose may need adjusting.

At Cosmo Clinic, the two-week review is part of the treatment. It is the moment to talk to the person who did the procedure.